What is Afyaimara Family Cover?
- Lifetime cover - Once you join, you can renew your cover for life
- Wide geographical coverage and hospital network - Access to all of Old Mutual General Insurance comprehensive network of hospitals across East Africa. An overseas referral is available for conditions not covered locally on accredited overseas partners
- Convenient - Air evacuation for cover limits above Kshs 1M and you get road evacuation for all cover limits. The cover on a reimbursement basis is valid for the first 60 days outside the geographical scope
- Affordable - No excess for inpatient cover, installment premium payments for your inpatient cover, and no claim discount
- Critical illness cover options - Members will also be provided with a critical illness cover with a cash pay-out of KES 750,000 for specific newly diagnosed critical illnesses. These illnesses are cancer, stroke, heart attack, renal/kidney failure, and paralysis
Please contact Old Mutual General Insurance or your insurance intermediary and fill the application form. Ensure you complete the application form in full and as accurately as possible to facilitate quick processing of your cover. Submit the duly filled form and the premium payment to Old Mutual General Insurance . All members as proposed will be issued with a membership card and a policy document will be issued for every proposal.
Persons over 60 years will be required to submit a medical report in the prescribed manner for eligibility.
Here you'll find useful tools and documents to help you get started and apply for our family cover.
- Inpatient limits from Kes 500,000 to Kes 10,000,000
- Optional outpatient cover from Kes 50,000 to Kes 200,000. This caters for:
- Routine outpatient services, consultations, diagnostics, drugs and dressings
- Routine dental and optical services, including the cost of frames, lenses
- Well baby clinics
- Covers pre-existing, chronic conditions & HIV/AIDs
- Cover for prematurity, and neonatal conditions
- Maternity cover within inpatient
- Dental and optical benefits included within the outpatient cover
- Hospitalization expenses including surgeon, physician, theatre, ICU & HDU fees
- Home nursing subject to pre-authorisation up to 90 days from discharge based on the applicable benefit sub-limit
- Diagnostics and physiotherapists fees, prescribed drugs, dressings, surgical appliances
- Accommodation costs for parent/guardian accompanying child of 12 years and below
- Covid-19 coverage
- Critical Illness Cover Lumpsum cash pay-out of KES 750,000
- The cover ceases to age for this benefit is 65 years
- Waiting period: 28 days waiting period for newly diagnosed chronic illnesses
- For the family cover, only one claim is paid in a single cover year
- Babies are covered from birth from 38 weeks and congenital conditions are excluded
- The cover limit is between Kenya, Uganda, Tanzania, Rwanda, and South Sudan.
- In case of services sought outside the specified region, the insured member’s claims shall be settled on reimbursement.
- Reimbursement will be on Old Mutual General Insurance Reasonable and customary rates.
- The cover on a reimbursement basis is valid for the first 60 days outside the geographical scope.
- Treatment(s) not available locally will be to a medical facility approved by the company and excludes Western Europe, Australia, USA, South Africa, and Canada
- The company has credit facilities in India, and the referral must be approved by the company and the respective government department
- Airfare for the patient and accompanying person on economy class is payable from the overall cover limit (inpatient), while accommodation costs are excluded
- Eligibility is for all persons and their legal dependents from age of zero (0) months to 65 years. Existing members can continue renewing in the scheme for life subject to renewal review by Old Mutual General Insurance
- Persons over 60 years will be required to submit a medical report in the prescribed manner for eligibility
- Eligible dependents include one spouse (age 18 to 65 years at joining) and own children from age of 0 months to 18 years of age. Children will be added on cover from birth. Birth Notification must be included in the application form
- Children above 19 years will be covered as principal persons
- Expenses where material information is withheld or misstated
- Infertility treatment
- Cosmetic surgery unless caused by accident
- Weight management treatments and drugs
- Participation in professional & hazardous sports e.g. bungee jumping, paragliding
- Treatment other than by registered medical practitioner
- Self-referred or self-prescribed treatment
- Drugs dispensed by the treating doctor
- Nutritional supplements unless prescribed as part of medical treatment
- Alternative treatment - Chiropractors, Acupuncturist, Herbalist
- Drunkenness, drug addiction, intentional self-injury
- Expenses incurred in connection with participation in Riot, Strike, and Civil commotion
- Naval, Military, or Air force operations
- Expenses recoverable under any other insurance e.g. NHIF, GPA, WIBA
- Beauty treatment in nature cure clinics or health hydro’s
- Diagnostic equipment (e.g. Glucometers, BP machines)
- Experimental treatment
- Contamination by radioactivity from nuclear fuel, waste, or fission
- Benefits not purchased or not indicated in the brochure
We offer comprehensive benefits such as:
Upfront payment is required. For members who require installments, we facilitate premium financing.
General exclusions are as follows:
*Refer to the policy document for detailed exclusions
28 days waiting period applies to illness claims and 60 days for surgical claims subject to specific condition waiting period indicated in the benefit schedule.